Following reports that sweeping, vital reforms of gender laws were dropped, due to recommendations attributed to Dr Michael Brady, which he has refuted, we wanted to take this opportunity to provide much needed clarity on why, for trans individuals, medical diagnosis should not be a requirement for a legal recognition of gender.
Classifying gender identity as a medical condition has been problematic. Those whose gender is simply different to that they were birth assigned, should not be classified as having a disease, or a disorder, or an illness.
Previous Classification of Diseases (ICD) classified gender identity related-health as Gender Identity Disorder in a category of mental health. This is now considered outdated and the latest ICD-11 now classifies gender identity related-health as “gender incongruence of adolescence and adulthood” and “gender incongruence of childhood” in the category of matters related to sexual health.
Pre-pubertal children do not require any medical intervention other than support for themselves and their family. However, adolescents may request interventions to suppress their natural puberty and replace their hormones so their bodies undergo pubertal changes related to their gender identity rather than their birth assigned gender. Adults who have already undergone puberty, may seek medication to change their hormone profile and others may opt for gender affirming surgery.
In line with the increase in people requesting medical intervention, healthcare professionals have rightly become more aware, carried out the necessary research and developed medical protocols accordingly, to better help their patients.
Unfortunately, there is still a significant amount of discrimination and prejudice faced by transgender people. Access to care is impacted by those who feel that gender identity cannot be different to sex, a position about which they feel very strongly and a lack of clear guidance which has allowed medical opinion to become divided.
Case studies, clinical experience and research studies are all very positive, showing that medical intervention can increase life satisfaction scores, reduce mental health issues and reduce self-harm and suicidality.
The World Professional Association for Transgender Health (WPATH) is an international, interdisciplinary, professional association devoted to the understanding and treatment of individuals with Gender Dysphoria (GD). In a position statement on medical necessity published in 2016, they recognise that ‘gender affirming/confirming treatments and surgical procedures, properly indicated and performed as provided by the Standards of Care, have proven to be beneficial and effective in the treatment of individuals with transsexualism or gender dysphoria.’
Following clarification from Dr Michael Brady on his position, we welcome more detail on how he intends to further support GRA and transgender healthcare reform.